Ewing Sarcoma in Children

What is Ewing sarcoma?

Ewing sarcoma is a rare type of cancer. It’s most common in children and teens between
the ages 10 and 19. It usually grows in bone, but it can also grow in soft tissue
that’s connected to the bone. This may include tendons, ligaments, cartilage, or muscles.

Ewing sarcoma most often grows in:

Bones of the legs, hips and pelvis, chest, and arms

Soft tissue of the torso, arms, and legs

What causes Ewing sarcoma in children?

The exact cause of Ewing sarcoma is not known. The cancer may be caused by changes
in the DNA of the cells. These changes are not passed on from parents to children.
They happen by chance.

What are the symptoms of Ewing sarcoma in children?

Symptoms can occur a bit differently in each child. They can include:

Pain around the site of the tumor that may come and go, but gets worse over time,
with activity, and at night

Swelling around the site of the tumor

A lump (mass)

Fever

Weight loss

Feeling tired

The symptoms of Ewing sarcoma can be like other health conditions. Make sure your
child sees a healthcare provider for a diagnosis.

How is Ewing sarcoma in children diagnosed?

Your child's healthcare provider will ask about your child's health history and symptoms.
He or she will examine your child. Your child may be referred to a specialist. This
may be a bone specialist (orthopedic surgeon) or a bone cancer specialist (orthopedic
oncologist). Your child may have tests such as:

X-ray. An X-ray uses a small amount of radiation to take pictures of bones and other body
tissues.

Blood tests. The blood is tested to look for signs of Ewing sarcoma. Genetic testing may also be
done to look for DNA changes that can cause the cancer.

CT scan. This test uses a series of X-rays and a computer to make detailed images of the body.

MRI. This test uses large magnets, radio waves, and a computer to make detailed images
of the inside of the body.

Bone scan. A small amount of dye is injected into a vein. The whole body is scanned. The dye
shows up in areas where there may be cancer.

Positron emission tomography (PET) scan. For this test, a radioactive sugar is injected into the bloodstream. Cancer cells
use more sugar than normal cells, so the sugar will collect in cancer cells. A special
camera is used to see where the radioactive sugar is in the body. A PET scan can sometimes
spot cancer cells in different areas of the body, even when they can’t be seen by
other tests. This test is often used in combination with a CT scan. This is called
a PET/CT scan.

Bone marrow aspiration or biopsy. Bone marrow is found in the center of some bones. It’s where blood cells are made. A small
amount of bone marrow fluid may be taken. This is called aspiration. Or solid bone
marrow tissue may be taken. This is called a core biopsy. Bone marrow is usually taken from
the hip bone. This test may be done to see if cancer cells have reached the bone marrow.

Tumor biopsy. A sample of the tumor is taken. It may be taken with a needle or by a surgical cut
(incision). It is checked under a microscope for cancer cells. A biopsy is needed
to diagnose neuroblastoma.

Part of diagnosing cancer is called staging. Staging checks the size and location
of the main tumor, if it has spread, and where it has spread. Ewing sarcoma may be
stage 1, 2, or 3 with sub-stages. Talk with your child's oncologist about your child's
stage and what it means. Staging also helps to decide the treatment.

How is Ewing sarcoma in children treated?

Treatment will depend on the stage and other factors. The cancer can be treated with
any of the below:

Surgery. Surgery may be done to try to save the arm or leg. This is known as limb-salvage
or limb-sparing surgery. Or surgery may be done to remove an arm or leg (amputation).
Surgery may be done to remove tumors in other parts of the body. Surgery is usually
followed by chemotherapy or radiation therapy.

Chemotherapy. These are medicines that kill cancer cells. They are usually given before surgery.
They may also be given after surgery. Your child may have a port or catheter inserted
in order to receive the medicines into a vein (IV). Chemotherapy is given in cycles
with periods of rest.

Radiation therapy. These are high-energy X-rays or other types of radiation. Radiation is used to kill
cancer cells or stop them from growing. It may be used when a tumor is hard to remove
with surgery.

High-dose chemotherapy with a stem cell transplant. Young blood cells (stem cells) are taken from the child or from someone else. This
is followed by a large amount of chemotherapy medicine. This causes damage to the
bone marrow. After the chemotherapy, the stem cells are replaced. This treatment may
be used when there is a high risk of cancer returning.

Supportive care. Treatment can cause side effects. Medicines and other treatments can be used for
pain, fever, infection, and nausea and vomiting.

Clinical trials. Ask your child's healthcare provider if there are any treatments being tested that
may work well for your child.

With any cancer, how well a child is expected to recover (prognosis) varies. Keep
in mind:

Getting medical treatment right away is important for the best prognosis. Cancer that
has spread is harder to treat.

Ongoing follow-up care during and after treatment is needed.

New treatments are being tested to improve outcome and to lessen side effects.

What are possible complications of Ewing sarcoma in children?

A child may have complications from the sarcoma or from treatment, such as:

How is Ewing sarcoma in children managed?

A child with a Ewing sarcoma needs ongoing care. Your child will be seen by oncologists
and other healthcare providers to treat any late effects of treatment and to watch
for signs or symptoms of the tumor returning. Your child will be checked with imaging
tests and other tests. And your child may see other healthcare providers for problems
from the tumor or from treatment. Your child may need therapy to help with movement
and muscle strength. This may be done by physical and occupational therapists.

You can help your child manage his or her treatment in many ways. For example:

Your child may have trouble eating. A dietitian may be able to help.

Your child may be very tired. He or she will need to balance rest and activity. Encourage
your child to get some exercise. This is good for overall health. And it may help
to lessen tiredness.

If your child smokes, help him or her quit. If your child doesn’t smoke, make sure
he or she knows the danger of smoking.

Get emotional support for your child. Find a counselor or child support group can
help.

Make sure your child attends all follow-up appointments.

When should I call my child’s healthcare provider?

Call the healthcare provider if your child has:

Symptoms that get worse

New symptoms

Side effects from treatment

Key points about Ewing sarcoma in children

Ewing sarcoma is a rare group of cancers that usually occur in the bone, but can also
occur in soft tissue.

X-ray and other imaging tests may be used in diagnosing Ewing sarcoma. A biopsy is
needed to make a definite diagnosis.

Ewing sarcoma is treated with chemotherapy followed by surgery and/or radiation therapy.
High-dose chemotherapy and stem cell transplant may be used in some children.

Continuous follow-up care during and after treatment is necessary.

Many complications can occur from the cancer and from the treatment. The complications
may be short- or long-term.

Next steps

Tips to help you get the most from a visit to your child’s health care provider:

Before your visit, write down questions you want answered.

At the visit, write down the names of new medicines, treatments, or tests, and any
new instructions your provider gives you for your child.

If your child has a follow-up appointment, write down the date, time, and purpose
for that visit.

Know how you can contact your child’s provider after office hours. This is important
if your child becomes ill and you have questions or need advice.